Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery

Abstract

Background: Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear. Methods: Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1•2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days. Results: Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0•043, P = 0•032 and P = 0•003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0-9) versus 6 (0-15); P = 0•013). They were less likely to consult their general practitioner (16.0 versus 24•3 per cent; P = 0•040) or to receive postoperative antibiotics (4•7 versus 13•5 per cent; P = 0•002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0•92 (95 per cent confidence interval (c.i.) 0•87 to 0•97); P = 0•005) and current smoking (OR 0•5 (0•3 to 0•9); P = 0•033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2•2 (95 per cent c.i. 1•3 to 3•6); P = 0•003). Conclusion: Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.